Artificial cerebrospinal fluid use during burr-hole surgery and reoperation rate in patients with chronic subdural hematoma: an analysis using a nationwide inpatient database.
Artificial cerebrospinal fluid
Burr-hole surgery
Chronic subdural hematoma
Recurrence
Reoperation
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
30
11
2022
accepted:
17
03
2023
medline:
1
5
2023
pubmed:
30
3
2023
entrez:
29
3
2023
Statut:
ppublish
Résumé
The optimal surgical procedure to reduce the recurrence rate of chronic subdural hematoma (CSDH) after burr-hole surgery remains to be established. This study aimed to investigate the association between artificial cerebrospinal fluid (ACF) use during burr-hole surgery and reoperation rate in patients with CSDH. In this retrospective cohort study, we used the Japanese Diagnostic Procedure Combination inpatient database. We identified patients aged 40-90 years who were hospitalized for CSDH and had undergone burr-hole surgery within 2 days of admission, between July 1, 2010 and March 31, 2019. We performed a one-to-one propensity score-matched analysis to compare the outcomes between patients with and without ACF irrigation during burr-hole surgery. The primary outcome was reoperation within 1 year of surgery. The secondary outcome was the total hospitalization costs. Of the 149,543 patients with CSDH from 1100 hospitals, ACF was used in 32,748 patients (21.9%). Propensity score matching created highly balanced 13,894 matched pairs. In the matched patients, the reoperation rate was significantly lower in the ACF users than that in the non-users group (6.3% vs. 7.0%, P = 0.015), with a risk difference of -0.8% (95% confidence interval, -1.5 to -0.2). There was no significant difference in the total hospitalization costs between the two groups (5079 vs. 5042 US dollars, P = 0.330). ACF use during burr-hole surgery may be associated with lower reoperation rate in patients with CSDH.
Sections du résumé
BACKGROUND
The optimal surgical procedure to reduce the recurrence rate of chronic subdural hematoma (CSDH) after burr-hole surgery remains to be established. This study aimed to investigate the association between artificial cerebrospinal fluid (ACF) use during burr-hole surgery and reoperation rate in patients with CSDH.
METHOD
In this retrospective cohort study, we used the Japanese Diagnostic Procedure Combination inpatient database. We identified patients aged 40-90 years who were hospitalized for CSDH and had undergone burr-hole surgery within 2 days of admission, between July 1, 2010 and March 31, 2019. We performed a one-to-one propensity score-matched analysis to compare the outcomes between patients with and without ACF irrigation during burr-hole surgery. The primary outcome was reoperation within 1 year of surgery. The secondary outcome was the total hospitalization costs.
RESULTS
Of the 149,543 patients with CSDH from 1100 hospitals, ACF was used in 32,748 patients (21.9%). Propensity score matching created highly balanced 13,894 matched pairs. In the matched patients, the reoperation rate was significantly lower in the ACF users than that in the non-users group (6.3% vs. 7.0%, P = 0.015), with a risk difference of -0.8% (95% confidence interval, -1.5 to -0.2). There was no significant difference in the total hospitalization costs between the two groups (5079 vs. 5042 US dollars, P = 0.330).
CONCLUSIONS
ACF use during burr-hole surgery may be associated with lower reoperation rate in patients with CSDH.
Identifiants
pubmed: 36991171
doi: 10.1007/s00701-023-05570-1
pii: 10.1007/s00701-023-05570-1
pmc: PMC10140006
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1289-1296Informations de copyright
© 2023. The Author(s).
Références
Adachi A, Higuchi Y, Fujikawa A et al (2014) Risk factors in chronic subdural hematoma: comparison of irrigation with artificial cerebrospinal fluid and normal saline in a cohort analysis. PLoS One 9(8):e103703. https://doi.org/10.1371/journal.pone.0103703
doi: 10.1371/journal.pone.0103703
pubmed: 25089621
pmcid: 4121178
Adachi A, Higuchi Y, Response to Toi et al (2019) Determining if cerebrospinal fluid prevent recurrence of chronic subdural hematoma: a multi-center prospective randomized clinical trial. J Neurotrauma 36(7):1192–1193. https://doi.org/10.1089/neu.2018.5821
doi: 10.1089/neu.2018.5821
pubmed: 30183549
Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46(3):399–424. https://doi.org/10.1080/00273171.2011.568786
doi: 10.1080/00273171.2011.568786
pubmed: 21818162
pmcid: 3144483
Bartley A, Bartek J Jr, Jakola AS et al (2023) Effect of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma: a randomized clinical trial. JAMA Neurol 80(1):58–63. https://doi.org/10.1001/jamaneurol.2022.4133
doi: 10.1001/jamaneurol.2022.4133
pubmed: 36409480
Bounajem MT, Campbell RA, Denorme F et al (2021) Paradigms in chronic subdural hematoma pathophysiology: current treatments and new directions. J Trauma Acute Care Surg 91(6):e134–e141. https://doi.org/10.1097/TA.0000000000003404
doi: 10.1097/TA.0000000000003404
pubmed: 34538825
Fujita Y, Doi K, Harada D, Kamikawa S (2010) Modulation of physiological hemostasis by irrigation solution: comparison of various irrigation solutions using a mouse brain surface bleeding model. J Neurosurg 112(4):824-828. https://doi.org/10.3171/2009.7.JNS09561
doi: 10.3171/2009.7.JNS09561
Gurelik M, Aslan A, Gurelik B, Ozum U, Karadag O, Kars HZ (2007) A safe and effective method for treatment of chronic subdural haematoma. J Neurosurg 34(1):84–87. https://doi.org/10.1017/s0317167100005849
doi: 10.1017/s0317167100005849
Koizumi S, Hayasaka T, Goto-Inoue N, Doi K, Setou M, Namba H (2012) Imaging mass spectrometry evaluation of the effects of various irrigation fluids in a rat model of postoperative cerebral edema. World Neurosurg 77(1):153–159. https://doi.org/10.1016/j.wneu.2011.03.039
doi: 10.1016/j.wneu.2011.03.039
Kuwabara M, Sadatomo T, Yuki K et al (2017) The effect of irrigation solutions on recurrence of chronic subdural hematoma: a consecutive cohort study of 234 patients. Neurol Med Chir 57(5):210–216. https://doi.org/10.2176/nmc.oa.2016-0228
doi: 10.2176/nmc.oa.2016-0228
pubmed: 28367840
pmcid: 5447812
Laumer R, Schramm J, Leykauf K (1989) Implantation of a reservoir for recurrent subdural hematoma drainage. Neurosurgery 25(6):991–996. https://doi.org/10.1097/00006123-198912000-00026
doi: 10.1097/00006123-198912000-00026
pubmed: 2601834
Liu W, Bakker NA, Groen RJ (2014) Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 121(3):665–673. https://doi.org/10.3171/2014.5.JNS132715
doi: 10.3171/2014.5.JNS132715
pubmed: 24995782
Mehta V, Harward SC, Sankey EW, Nayar G, Codd PJ (2018) Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci 50:7–15. https://doi.org/10.1016/j.jocn.2018.01.050
doi: 10.1016/j.jocn.2018.01.050
pubmed: 29428263
Ministry of Health LaW (2016) Labour and Welfare Statistical Surveys 2016. Japan Ministry of Health [Available from: mhlw.go.jp/stf/seisakunitsuite/bunya/open_data.html
Ohbe H, Sasabuchi Y, Yamana H, Matsui H, Yasunaga H (2021) Intensive care unit versus high-dependency care unit for mechanically ventilated patients with pneumonia: a nationwide comparative effectiveness study. Lancet Reg Health West Pac 13:100185. https://doi.org/10.1016/j.lanwpc.2021.100185
doi: 10.1016/j.lanwpc.2021.100185
pubmed: 34527980
pmcid: 8350066
Oka K, Yamamoto M, Nonaka T (1996) Tomonaga M (1996) The significance of artificial cerebrospinal fluid as perfusate and endoneurosurgery. Neurosurgery 38(4):733–736
doi: 10.1227/00006123-199604000-00019
pubmed: 8692392
Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682. https://doi.org/10.1093/aje/kwq433
doi: 10.1093/aje/kwq433
pubmed: 21330339
Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83
doi: 10.1097/01.mlr.0000182534.19832.83
pubmed: 16224307
Rauhala M, Helén P, Huhtala H et al (2020) Chronic subdural hematoma-incidence, complications, and financial impact. Acta Neurochir (Wien). 162(9):2033–2043. https://doi.org/10.1007/s00701-020-04398-3
doi: 10.1007/s00701-020-04398-3
pmcid: 7415035
Santarius T, Kirkpatrick PJ, Ganesan D et al (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374(9695):1067–1073. https://doi.org/10.1016/S0140-6736(09)61115-6
doi: 10.1016/S0140-6736(09)61115-6
pubmed: 19782872
Tahsim-Oglou Y, Beseoglu K, Hänggi D, Stummer W, Steiger HJ (2012) Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis. Acta Neurochir 154:1063–1068. https://doi.org/10.1007/s00701-012-1334-0
doi: 10.1007/s00701-012-1334-0
pubmed: 22476866
Takayama M, Terui K, Oiwa Y (2012) Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis. No Shinkei geka. Neuro Surg 40(10):871–876
pubmed: 23045401
Tatsuya N, Tomo O, Takehiro T, Horoshi O, Tamotsu M (2011) Benefits of Artcereb® on the irrigation of chronic subdural hematoma. Traumatology 34:167–171
Toi H, Fujii Y, Iwama T et al (2019) Determining if cerebrospinal fluid prevents recurrence of chronic subdural hematoma: a multi-center prospective randomized clinical trial. J Neurotrauma 36(4):559–564. https://doi.org/10.1089/neu.2018.5821
doi: 10.1089/neu.2018.5821
pubmed: 29901422
Tommiska P, Raj R, Schwartz C et al (2020) Finnish study of intraoperative irrigation versus drain alone after evacuation of chronic subdural haematoma (FINISH): a study protocol for a multicentre randomised controlled trial. BMJ Open 10(6):e038275. https://doi.org/10.1136/bmjopen-2020-038275
doi: 10.1136/bmjopen-2020-038275
pubmed: 32565480
pmcid: 7311024
WHO Expect Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403):157–163. https://doi.org/10.1016/S0140-6736(03)15268-3
doi: 10.1016/S0140-6736(03)15268-3
Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H (2017) Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 27(10):476–482. https://doi.org/10.1016/j.je.2016.09.009
doi: 10.1016/j.je.2016.09.009
pubmed: 28142051
pmcid: 5602797
Yumoto T, Naito H, Yorifuji T, Aokage T, Fujisaki N, Nakao A (2019) Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients. BMC Emerg Med 19(1):65. https://doi.org/10.1186/s12873-019-0282-x
doi: 10.1186/s12873-019-0282-x
pubmed: 31694575
pmcid: 6836363